SUMMARY WGU PATHO D236 FALL COMPLETE A+ SOLUTION GUIDE

SUMMARY WGU PATHO D236 FALL COMPLETE A+ SOLUTION GUIDE


Papilledema
 Optic disc swollen with blurred edges due to increased intracranial pressure (ICP) secondary to bleeding,
brain tumor, abscess, pseudotumor cerebri

Optic Neuritis
 Multiple Sclerosis (Optic Neuritis)
o Young adult with new or intermittent loss of vision of one eye (optic neuritis) alone or
accompanied by nystagmus or other abnormal eye movements. May be accompanied by other
neurological symptoms (aphasia, paresthesia, abnormal gait, spasticity, etc.). Complains of daily
fatigue on awakening that worsens as day goes on. Heat exacerbates and worsens symptoms
(heat sensitivity). Has recurrent episodes. Refer to neurologist.


Palpebral conjunctiva-Mucosal lining inside eyelids

Retinopathy-disease of the retina which results in impairment or loss of vision

Proptosis-bulging of the eyeball

Presbyopia-Age-related visual change due to a decreased ability of the eye to accommodate stiffening of the
lenses; usually starts at the age of 40 years; near vision is affected with decreased ability to read small print at
close range

Cholesteatoma
 “Cauliflower-like” growth accompanied by foul-smelling ear discharge. Hearing loss on affected ear. On
examination, no tympanic membrane or ossicles are visible because of destruction by the tumor. History of
chronic otitis media infection. The mass is not cancerous, but it can erode into the bones of the face and
damage the facial nerve (CN VII). Treated with antibiotics and surgical debridement. Refer to
otolaryngologist.

Periorbital Ecchymosis- “Racoon Eyes”

Cerumen- Earwax; the color can range from yellow to dark brown

Odynophagia- pain on swallowing

Leukoplakia-White to light-gray patch that appears on tongue, floor of mouth, or inside cheek. Rule out oral
cancer. Chewing or smoking tobacco and alcohol abuse are risk factors for oral cancer.

Aphthous Stomatitis (canker sores)- Painful shallow ulcers on soft tissue of the mouth that usually heal within 7
to 10 days. Cause is unknown. Treat symptoms with “Magic mouthwash” (combination of liquid diphenhydramine,
viscous lidocaine, and glucocorticosteroid). Swish, hold, and spit every 4 hours as needed.

Buccal Mucosa- mucosal lining inside the mouth

Cheilosis (Angular Cheilitis, Perleche)
 Painful skin fissures and maceration at the corners of the mouth due to excessive moisture. More common
in elderly with dentures. Can be acute or chronic.
 Secondary infection with Candida albicans (yeast) or bacteria (Staphylococcus aureus). Multiple etiologies
such as oversalivation, poorly fitting dentures, nutritional deficiencies, lupus, autoimmune disease, irritant
dermatitis, squamous cell carcinoma, and pacifier use in children.

Soft Palate-refers to the area where uvula, tonsils, anterior of throat are located

Hard Palate-“Roof” of the mouth

Hyperopia- far-sightedness
Myopia- near-sightedness

Cobblestoning-Hyperplastic lymphoid tissue on the posterior pharynx

Key Questions
1. At what age should children reach visual acuity of 20/20? When should you refer children to an ophthalmologist?
 By the age of 6 years, visual acuity (retina or CN II) is 20/20 in both eyes
 If the child’s vision is not at least 20/30 in either eye by age 6 years, refer to ophthalmologist.

2. What is a Snellen test used for? How is it administered?
Definition of a Snellen test result 20/60: Measures Central Distance Vision

,  Top number (or numerator): The distance in feet at which the patient stands from the Snellen or picture
eye chart (always 20 feet and never changes).
 Bottom number (or denominator): The number of feet that the patient can see compared to a person with
normal vision (20/20 or less).
 Number changes, dependent on patient’s vision. In this example, the patient can see at 20 feet what a
person with normal vision can see at 60 feet.
 Legal blindness: Defined as a best corrected vision of 20/200 or less or a visual field less than 20
degrees (tunnel vision).

. What test checks for colorblindness?
 Ishihara Chart
What are some of the most common kind of eye pathologies
 Papilledema
o Optic disc swollen with blurred edges due to increased intracranial pressure (ICP) secondary to
bleeding, brain tumor, abscess, pseudotumor cerebri
 Hypertensive Retinopathy (Figure 5.2)
o Copper and silver wire arterioles (caused by arteriosclerosis)
o Arteriovenous nicking (when arteriosclerotic arteriole crosses retinal vein, it indents the vein)
o Retinal hemorrhages
 Primary Open-Angle Glaucoma Gradual onset of increased IOP greater than 22 mmHg due
to blockage of the drainage of aqueous humor inside the eye. The retina (CN 2) undergoes
ischemic changes and, if untreated, becomes permanently damaged. Most common type of
glaucoma (60%–70%).
o Check IOP (use tonometer). Normal range: 8 to 21 mmHg. IOP of 30 mmHg or more
is considered very high. Urgent referral within 24 hours or less to ophthalmologist or
refer to ED.
 Primary Angle-Closure Glaucoma Sudden blockage of aqueous humor causes marked
increase of the IOP, resulting in ischemia and permanent damage to the optic nerve (CN II).
REFER TO ED
 Anterior Uveitis (Iritis) Insidious onset of eye pain with conjunctival injection (redness;
note that injection of the eye means the superficial blood vessels of the conjunctiva are
prominent [red eyes]) located mainly on the limbus (junction between cornea and sclera) that
is a complication of autoimmune disorders (rheumatoid arthritis [RA], lupus, ankylosing
spondylitis), sarcoidosis, syphilis, others. No purulent discharge (as in bacterial
conjunctivitis). Refer to ophthalmologist for management as soon as possible within 24 hours.
Anterior uveitis can result in blindness.
 Age-Related Macular Degeneration (AMD) Usually asymptomatic during the early
stages. Caused by gradual damage to the pigment of the macula (area of central vision) that
results in severe visual loss to blindness. Leading cause of blindness in the elderly. More
common in smokers. AMD can either be atrophic (dry form) or exudative (wet form). The dry
form of AMD is more common (85%–90%) and is “less severe” compared to the wet form. The
wet form of AMD is responsible for 80% of vision loss (choroidal neovascularization).
 Sjögren’s Syndrome Chronic autoimmune disorder characterized by decreased function of
the lacrimal and salivary glands. It can occur alone or with another autoimmune disorder (i.e.,
with rheumatoid arthritis).
 Blepharitis Chronic condition caused by inflammation of the eyelids (hair follicles,
meibomian glands). Associated with seborrheic dermatitis and rosacea. Lid may be colonized
by staphylococcal bacteria. Intermittent exacerbations. Complains of itching or irritation in
the eyelids (upper/lower or both), gritty sensation, eye redness, and crusting.
o Treatment Plan Johnson’s Baby Shampoo with warm water: Gently scrub eyelid
margins until resolves. Consider topical antibiotic solution (erythromycin eye drops)
to eyelids two to three times/day (lid hygiene). Commercial eye lid scrub products
are available.
o Warm compress to eyelids two to four times/day during exacerbations to soften
debris and relieve itching.

6. What are conditions that can lead to Increased Cranial Pressure (ICP)?
GLAUCOMA

7. Identify the eye conditions that are considered a medical emergency?
HIGHLIGHTED IN RED ABOVE

8. Explain degenerative changes that can happen to the eye with age
Age-Related Macular Degeneration
 Usually asymptomatic during the early stages.
 Caused by gradual damage to the pigment of the macula (area of central vision) that results in severe
visual loss to blindness.
 Leading cause of blindness in the elderly.

,  More common in smokers.
 AMD can either be atrophic (dry form) or exudative (wet form).
o The dry form of AMD is more common (85%–90%) and is “less severe” compared to the wet form.
o The wet form of AMD is responsible for 80% of vision loss (choroidal neovascularization).




 Sjögren’s Syndrome
o Chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary
glands. It can occur alone or with another autoimmune disorder (i.e., with rheumatoid arthritis).
. Discuss the different kind of hearing loss
 Conductive Hearing Loss (Outer Ear and Middle Ear)
o Any type of obstruction (or conduction) of the sound waves will cause conductive hearing loss.
Other causes include blockage of the outer ear (ceruminosis, otitis externa) or fluid inside the
middle ear (otitis media, serous otitis media).
 Sensorineural Hearing Loss (Inner Ear)
o Damage (or aging) of the cochlea/vestibule (presbycusis, Ménère’s disease) and/or to the nerve
pathways (CN VIII or acoustic nerve) causes sensorineural hearing loss. Other causes are ototoxic
drugs (oral aminoglycosides, erythromycin, tetracyclines, high-dose aspirin, sildenafil, etc.) and
stroke. Usually results in permanent hearing loss.


12. Learn the descriptions of eye findings such as pinguecula, pterygium, and chalazion.
 Pinguecula
o A raised yellow to white small round growth in the bulbar conjunctiva (skin covering eyeball) next
to the cornea. Located on the nasal and temporal side of the eye. Caused by chronic sun
exposure.
 Pterygium (Figure 5.6)
A yellow triangular (wedge-shaped) thickening of the conjunctiva that extends across the cornea on the nasal side.
Results from chronic sun exposure. Sometimes called surfer’s eye. Can be red or inflamed at times. May complain of
foreign body sensation on the eye.

13. Describe the Weber and Rinne tests
o Weber Test
o Place the tuning fork midline on the forehead. Normal finding: No lateralization. If lateralization
(hears the sound in only one ear), abnormal finding.
o Rinne Test
Place tuning fork first on mastoid process, then at front of the ear. Time each area. Normal finding: Air conduction
(AC) lasts longer than bone conduction (BC; i.e., can hear longer in front of ear than on mastoid bone).

. Describe the condition of Cheilosis and how to treat it
o Cheilosis (Angular Cheilitis, Perleche)
o Painful skin fissures and maceration at the corners of the mouth due to excessive moisture. More
common in elderly with dentures. Can be acute or chronic.
o Secondary infection with Candida albicans (yeast) or bacteria (Staphylococcus aureus). Multiple
etiologies such as oversalivation, poorly fitting dentures, nutritional deficiencies, lupus,
autoimmune disease, irritant dermatitis, squamous cell carcinoma, and pacifier use in children.
o Treatment Plan
 Check B12 level to rule out pernicious anemia with cheliosis
 Remove underlying cause. Check if dentures fit correctly; if loose, refer to dentist.
 If yeast infection is suspected, microscopy with KOH. If positive (pseudohyphae and
spores), treat with topical azole ointment (e.g., clotrimazole, miconazole) BID.
 If suspect staphylococcal infection, C&S. If positive, treat with topical mupirocin ointment
BID.
 When infection has cleared, use barrier cream with zinc or petroleum jelly applied at
night. High rate of recurrence.

20. Describe the manifestations of peritonsillar abscess
o Peritonsillar Abscess
o Severe sore throat
o difficulty swallowing
o odynophagia (pain on swallowing)
o trismus (jaw muscle spasm making it difficult to open mouth)
o “hot potato” voice.
o Unilateral swelling of the peritonsillar area and soft palate.
o Affected area is markedly swollen and appears as a bulging red mass with the uvula displaced
away from the mass.